了解谁在领导：定义护士领导的项目

分享智慧

共同成长

Full text

The nursing workforce has worked hard to professionalise and demonstrate the importance contribution of the nursing profession for quality global health care. The International Council of nurses defines a nurse as one who has completed a basic nursing education and is authorised to practice in their country (ICN, 1987). The ICN definition of nurses also specifically requires that nurses be prepared and authorised to “be involved in research” (ICN, 1987). As leaders in health care provision, nurses advocate tirelessly for their patients and play an important role in promoting and sustaining evidence-based healthcare (Bianchi et al., 2018). It is important that this nursing leadership is acknowledged in consumer care, and in research, innovation and improvement in healthcare delivery.

During the conduct of a systematic review examining nurse roles in physical healthcare of people with mental health, we along with colleagues encountered a clear example of the ad hoc approach to leadership attribution in nursing research (CRD42022321337). While there is clarity around the definition of who is a nurse, there is considerable ambiguity regarding studies that are “nurse-led.” Moreover, clear criteria that define nurse leadership in research pertaining to physical healthcare of people experiencing mental health concerns seem absent from the literature. This ambiguity appears as a continuum and includes studies where “nurse-led” described the role of a nurse as one who collected data, studies where nurses conducted the project yet remain absent from the authorship team, studies where the data was collected by an exercise physiologist or other non-nurse practitioner yet discussion of the nursing role appeared throughout the paper, and studies where nurses were clearly included on the authorship team but reference to nurses or the nursing profession were absent when discussing the study implications. While we acknowledge the diverse roles nurses play in research studies, absence of defined contribution makes the task of identifying the nursing contribution incredibly complex and fails to acknowledge nurses as research leaders.

To gain a greater understanding of the scope and value of nurse-led research we suggest a standardised definition of nurse-led research is adopted, allowing authors to assess and classify research activities appropriately. We recommend such definition is included in all publications of nurse-led work.

We propose that any definition would first require a project to clearly associate with nursing practice:

1. The project is clearly within the scope of nursing practice;

2. There is a clear articulation of the connection between the project and implications; for future nursing/nurses/nursing care.

And involve a nurse/nurses in at least three of the following four areas:

1. Project conception or design;

2. Leading the project; for example, working as the project manager/supervisor of staff conducting integral components of the project;

3. Undertaking integral components of the project such as data collection, facilitating organisational access or patient recruitment;

4. Project promotion and reporting or its dissemination in peer reviewed literature.

Defining the term “nurse-led” in the research context may serve multiple benefits. Firstly, a definition of what research is nurse-led would reduce ambiguity around the role and importance of nurses in research. There is a continued lack of awareness within the general community of the involvement that nurses have in research and the impact of projects that nurses lead on quality of patient care (Nieswiadomy & Bailey, 2018). A clear definition of nurse-led research would allow for more streamlined and targeted professional promotion.

Secondly, as the role of nurses in leading research becomes more clearly identified, it will allow better promotion of nursing research and simplified implementation of relevant research to practice. If academics, and practicing or student health professionals can utilise a single search term such as “nurse-led” to identify practical, relevant research that can be applied to nursing practice, this may encourage research engagement. Nurses working clinically would benefit from clearly defined terminology that allowed them to easily search and identify information that is directly related to their role and scope. Encouraging the use of “nurse-led” as an unambiguous key word would also improve the pragmatics of literature searching and assist in highlighting the importance of nursing in research and research as a career pathway for nurses.

There are a variety of organisations that aim to encourage nurses to engage in research, such as the National Institute of Nursing Research in the United States and the International Association of Clinical Research Nurses globally. Nursing courses often incorporate training relating to research conduct. In Australia, the Australian Nursing and Midwifery Federation has mandated that “research must be a recognised and visible career pathway within all Nursing and Midwifery classification structures” (ANMF, 2019). The visibility of Nursing Research could be improved, and the direct relevance of research to practice could be more easily articulated with the use of a nurse-led as a well-defined concept.

In the systematic review noted previously a definition of nurse-led consistent with the above-described criteria was applied. Subsequently 256 studies or 46.6% of the 549 studies included at full text review were excluded. This is not to imply nurses were not included in some aspect of the excluded projects, but does highlight the difficulty that an absence of a pre-defined definition of nurse -led creates, since some potentially included papers may have been inadvertently excluded.

Nursing research and nurse involvement in healthcare research are increasing (Bianchi et al., 2018). Now is the time to define and agree upon a definition that can be used to identify nurse-led projects in a way that is clearly distinguishable. Having a clear definition of nurse-led projects has the potential to provide significant benefit to the nursing profession.

全文翻译（仅供参考）

护理工作人员努力实现专业化，并证明护理专业对全球医疗质量的重要贡献。国际护士理事会将护士定义为已完成基本护理教育并被授权在本国执业的护士（ICN，1987）。ICN对护士的定义还特别要求护士做好准备并获得授权“参与研究”（ICN，1987）。作为医疗保健领域的领导者，护士孜孜不倦地为患者辩护，并在促进和维持循证医疗保健方面发挥重要作用（Bianchi等人，2018年）。重要的是，这种护理领导力在消费者护理、研究、创新和医疗保健提供方面得到认可。

在对心理健康患者的物理保健中的护士角色进行系统审查的过程中，我们和同事们遇到了一个明确的例子，即护理研究中领导归因的特殊方法（CRD42022321337）。虽然关于谁是护士的定义是明确的，但关于“护士主导”的研究存在相当大的模糊性。此外，文献中似乎没有明确的标准来定义护士在与心理健康问题患者的身体健康相关的研究中的领导作用。这种模糊性表现为连续性，包括“护士领导”将护士的角色描述为收集数据的人的研究、护士进行项目但仍不在作者团队中的研究、由运动生理学家或其他非护士从业者收集数据但对护理角色的讨论贯穿论文的研究、，在研究中，护士被明确纳入作者团队，但在讨论研究含义时，没有提及护士或护理专业。虽然我们承认护士在研究中所扮演的不同角色，但由于缺乏明确的贡献，确定护理贡献的任务变得极其复杂，无法承认护士是研究领导者。

为了更好地理解护士主导的研究的范围和价值，我们建议采用护士主导研究的标准化定义，允许作者对研究活动进行适当的评估和分类。我们建议将此定义纳入所有护士主导工作的出版物中。

我们建议，任何定义都首先要求项目与护理实践明确相关：

该项目显然属于护理实践范围；

项目与影响之间有明确的联系；用于未来护理/护士/护理。

并让护士至少参与以下四个领域中的三个：

项目构思或设计；

领导项目；例如，担任执行项目组成部分的员工的项目经理/主管；

承担项目的组成部分，如数据收集、促进组织访问或患者招募；

项目推广和报告或在同行评审的文献中传播。

在研究背景下定义“护士主导”一词可能有多种益处。首先，定义什么是护士主导的研究将减少围绕护士在研究中的角色和重要性的模糊性。普通社区对护士参与研究以及护士领导的项目对患者护理质量的影响仍然缺乏认识（Nieswiadomy&Bailey，2018）。护士主导研究的明确定义将有助于更精简和更有针对性的专业晋升。

其次，随着护士在领导研究中的作用越来越明确，这将有助于更好地促进护理研究，并简化相关研究的实施。如果学者、执业或学生健康专业人员可以使用“护士主导”等单一搜索词来识别可应用于护理实践的实用相关研究，这可能会鼓励研究参与。临床护士将受益于明确定义的术语，使他们能够轻松搜索和识别与其角色和范围直接相关的信息。鼓励使用“护士主导”作为一个明确的关键词，也将提高文献检索的实用性，并有助于强调护理在研究中的重要性，并将其作为护士的职业道路。

有许多旨在鼓励护士参与研究的组织，如美国国家护理研究所和全球国际临床研究护士协会。护理课程通常包括与研究行为相关的培训。在澳大利亚，澳大利亚护理和助产联合会（Australian Nursing and Missifery Federation）规定，“研究必须是所有护理和助产士分类结构中公认且可见的职业道路”（ANMF，2019）。护理研究的可见度可以提高，研究与实践的直接相关性可以更容易地通过使用护士作为明确定义的概念来表达。

在先前提到的系统审查中，采用了与上述标准一致的护士领导定义。随后，256项研究或全文审查中549项研究的46.6%被排除在外。这并不是说护士没有被排除在被排除项目的某些方面，而是强调了缺乏护士主导的预定义定义所带来的困难，因为一些潜在的被排除论文可能是无意中被排除的。

护理研究和护士参与医疗保健研究的人数正在增加（Bianchi等人，2018年）。现在是定义和商定一个定义的时候了，这个定义可以用来明确区分护士主导的项目。对护士主导的项目有一个明确的定义，有可能为护理专业带来巨大的好处。

THE

END